On Jan. 24, Gov. Peter Shumlin presented his budget for the state of Vermont. Included in his proposals was funding to help Vermonters with some of the cost-sharing requirements under the soon-to-be health care exchange.

Charts comparing the initial cost-sharing requirements (premiums, copays and deductibles) as put forward by the Green Mountain Care Board and Shumlin’s proposals show clearly that the governor has narrowed the gap. However, it’s not enough. While we may be moving forward for some with the expansion of Medicaid, we can’t move backward for others.

If Vermonters currently on VHAP or Catamount — programs that will end with the opening of the exchange — are faced with large increases in cost-sharing requirements, they will likely drop insurance and again have only free clinics and hospital emergency rooms to turn to for health care. Similarly, if people new to the exchange find these costs too daunting, they will choose to pay the relatively nominal penalty and become uninsured.

At the People’s Health & Wellness Clinic in Barre, one of Vermont’s 10 free clinic programs, we’ve been assisting people with application and enrollment in Vermont’s health insurance programs for years. Our lengthy experience has shown that no matter how good a job we do, some people are still getting their eligibility and premium notices and saying they simply can’t afford the current rates. Or, they dig deep and make a month’s payment or two, but then can’t stick with it.

These folks also won’t be able to get back into the exchange under the new open enrollment period restrictions until the following year, even if they were able to find a way to pay. This is another change from the current system, which allows us to enroll patients in the state’s insurance programs year-round.

We are proud to deliver quality care to our patients, but we see ourselves as only a temporary medical home. Getting our patients on insurance is better for them, their families and their employers, making them more productive at home and at work. It’s also better for the health care system, helping avoid cost shifting, and inappropriate and costly use of hospital emergency rooms.

I’m glad the governor has bitten off a piece of the pie; it makes it a little easier for the Legislature to do the rest. However, if the canyon is 60 feet wide, and the governor shrinks it to only 30 but the patient can only jump 10, it doesn’t make any difference.

Peter Youngbaer is the director of the People’s Health & Wellness Clinic in Barre.